The combination of long-term health conditions can matter more than how many you have
18 Feb 2025
The combinations of long-term health conditions may matter more for health outcomes, than how many long-term conditions a patient has.
This is according to research recently published in The Lancet eClinical Medicine. This understanding of multiple long-term conditions and how they interact could have important implications for future prevention and healthcare programmes, with a greater need for personal care plans for people living with multiple long-term conditions.
In the UK around 20-40% of adults are living with multiple long-term health conditions, typically defined as the co-existence of two or more chronic conditions, with the figure rising to more than 50% in people aged over 65 years. Care and treatment options for people with multiple long-term conditions, often referred to as multimorbidity, is complex and difficult. The rising number people living with multiple long-term health conditions, is becoming one of the greatest challenges facing the NHS.
The research looked at health data of more than half a million people from the UK, across four different age groups from 18 years upwards. They found that different groups, or clusters, of people with specific combinations of multiple long-term conditions had higher mortality rates, more hospitalisations, and more visits to the GP than others. Those that experienced multiple long-term conditions related to chronic pain, cardiovascular diseases or mental health issues had some of the worst health outcomes over ten years.
In tandem with a second piece or work recently published in BMC Medicine, the research highlights that living with multiple long-term conditions has a profound impact on health and quality of life for patients, and that combinations of long-term conditions can be more important than the number of long-term conditions patients have.
Dr Stefanie J. Krauth is a Lecturer in Canterbury Christ Church University’s School of Allied Health Professions, Public Health, and Social Work. She was the lead author for The Lancet eClinical Medicine report and was part of the NIHR funded PERFORM (Personalised Exercise-Rehabilitation For people with Multiple long-term conditions (multimorbidity) project, jointly led by Professor Sally Singh at the University of Leicester and Professor Rod Taylor at the University of Glasgow.
Dr Krauth said: “We have an increasing number of ever younger people living with multiple long-term conditions, which is known to be associated with a higher mortality rate, more hospitalisations and GP visits, and a lower quality of life.
“This study examines how the groupings or clusters of multiple long-tern conditions differ in their association with mortality, hospitalisations and general practice use across multiple data sets. It has enabled us to demonstrate how specific combinations of long-term conditions can have greater adverse health outcomes, and may matter more for mortality and demand on healthcare support, than how many long-term conditions people have.
“We also found that certain conditions tend to occur more regularly in combination, for example different groupings of conditions related to pain such as rheumatoid arthritis, migraines, and other painful conditions, appear in most age groups. Similarly, various groupings of heart and metabolism-related conditions (cardiometabolic conditions), including heart diseases, hypertension, kidney disease, diabetes, and vascular conditions exist in different age groups and become more important for health in middle aged and older patients.
“Personalising care and treatment programmes around multiple long-tern condition clusters that have higher risk of adverse outcomes may have important implications for practice. It could inform decision making around healthcare service design and resourcing and be important for clinical practice and multimorbidity intervention research in the future.”